Atherosclerosis is a disease that affects hundreds of thousand of people each year. The disease can occur anywhere throughout the body including the lower extremities, the carotid arteries and the heart. When it affects the blood supply to the heart it is called coronary artery disease. Vascular complications produced by atherosclerosis, such as stenosis, aneurysm, rupture or occlusion oftentimes call for surgical intervention. If the disease is extensive, the affected artery or vessel is no longer reliable and is often replaced or bypassed around by a bypass graft, usually referred to as an “autograft.” To this end, the involved section of the vessel is bypassed with an autograft surgically attached proximal to the lesion and at a point distal to the lesion to provide a bypass path for blood flow. In a patient who undergoes coronary artery bypass grafting (CABG) surgery, a non-critical vessel (artery or vein) is harvested from elsewhere in the body and is sewn into place in such a manner that reestablishes the flow of blood to the heart region that had lost or diminished its supply of blood because of the atherosclerotic lesion.
The saphenous vein in the leg is a vessel that is commonly harvested for use as a bypass graft in coronary artery surgery. It is also common to use the saphenous vein for bypass surgery in the lower extremity to bypass lesions in the femeral or popliteal arteries. However, typical procedures for harvesting a saphenous vein autograft are tedious, time consuming, and cause undesirable patient trauma. In one harvesting procedure, an incision is made along the leg for a length corresponding to the length of the autograft required, wherein the vein is transected and is stripped from the leg. The incision then must be sutured or stapled along its length. In some patients, the incision must be made along the entire length of the leg. The surgery required for harvesting a vessel in this manner is traumatic to the patient, increases recovery time, increases the patient's hospital confinement, and adds to the cost of the coronary artery surgery.
Another method of harvesting a saphenous vein is by use of an endoscope. In this method, a few small incisions are made on the leg over the saphenous vein. The saphenous vein is transected and ligated at its ends and the endoscope is inserted into the small incisions. While visualizing the vein with the endoscope, the entire length of the vein is harvested by slow dissection. The endoscope is advanced under the skin along the saphenous vein's length while transecting and ligating its connecting branches until the entire segment of the saphenous vein is free and is able to be removed. This method is more advantageous to the patient in that only a few small incisions are made and much less scarring occurs. However, the endoscopic harvesting of the vein is a difficult procedure and takes a substantial amount of time. The increased time in the operating room increases the cost of the procedure and increases the risk of infection and complications to the patient.
Other vessels are often used as well in bypass surgical procedures. For example, the radial arteries are often used as coronary conduits. The lesser saphenous, basilic, and cephalic veins are also used.
Accordingly, it would be highly desirable to provide a less invasive procedure for harvesting vessels, especially the saphenous vein, which avoids the need for a long incision, is easy to use, and does not require a substantial amount of time to complete.